Indications

A newborn infant relies on its nasal airway. It is particularly compromised during suckling. It is not possible to leave bilateral choanal atresia untreated. Rapid assessment and correction are needed to provide a nasal airway, and an oropharyngeal airway has to be held in place in the meantime. Bilateral choanal atresia is often associated with other congenital abnormalities (the CHARGE syndrome in particular) that also need to be investigated.

First of all an attempt to pass a fine nasogastric tube into the nasopharynx should be made to help confirm the diagnosis. An axial CT should be done, but only after decongesting the mucosa and sucking any mucus (this avoids mucus producing the false appearance of a mucosal obstruction). A unilateral atresia often presents later in the early teens when the patient realizes that they cannot breathe through one side. They can also present with a unilateral mucoid discharge.

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